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Environmental Health Department <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />3 g g6.Approximate attendance at peak time: Total Attendance:Average Age <br />UTILITIES <br />1. <br />2. <br />3. <br />34. <br />Irs5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Event Coordinator: Date: <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor <br />Are janitorial facilities available: <br />Number of toilets provided: <br />Name of sanitary garbage disposal company: TE-4d <br />Method of disposal of liquid waste for food booths: <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of $152 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br /> No <br /> No <br /> No <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />SAN JOAQUIN <br />COUNTY <br />Q^es <br />E^Yes <br />□'Yes <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at a <br />minimum three-hour overtime rate of $684.00 <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />standards and the Environmental Health Department policies and procedures. <br />7/^ l L <br />___________Number of dumpsters: <br />1868 E. Hazelton Avenue | Stockton. California 95205 j T 209 468-3420 | F 209 464-0138 j www.sjgov org/ehd <br />EHD 164)2 Page 1 of 11 TEMP EVENT APP <br />06/19/19 <br />GENERAL EVENT FILE INFORMATION <br />MoOMtaIU H0QA& UlL-) <br />Date(s) of Event: I Time of Event: ) I A <br />Location: CCa/tAAl- CcaamO V ITT <br />Event Coordinator (Name): A £> A ‘—Telephone: (^f <br />Mailing Address: 4 4'0 fJ V CaTfUjCaXST; urfutu/ <br />Number of Food Booths: